Provider Demographics
NPI:1245389386
Name:METHODIST SPECIALTY CARE CENTER
Entity type:Organization
Organization Name:METHODIST SPECIALTY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-420-7760
Mailing Address - Street 1:1 LAYFAIR DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9717
Mailing Address - Country:US
Mailing Address - Phone:601-420-7760
Mailing Address - Fax:601-420-7770
Practice Address - Street 1:1 LAYFAIR DR
Practice Address - Street 2:SUITE 500
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9717
Practice Address - Country:US
Practice Address - Phone:601-420-7760
Practice Address - Fax:601-420-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04477051Medicaid